Articolo del 14/03/2025
A Muscle- and Tendon-Preserving Technique
Hip replacement surgery is one of the most common orthopedic procedures, especially for patients suffering from osteoarthritis, degenerative conditions, or traumatic injuries such as femoral head osteonecrosis, hip dysplasia, slipped capital femoral epiphysis, and Perthes disease.
We explore this topic with Dr. Marco Villa, an orthopedic specialist in hip prosthetics at Arsbiomedica.
Hip replacement is highly sought after due to its exceptional success rate and rapid recovery time. As a weight-bearing joint subjected to significant mechanical stress from daily activities, sports, and work, the hip often requires surgical intervention. Among all joint replacement procedures, hip prosthesis surgery offers one of the highest patient satisfaction rates and allows for a quick return to work, social activities, and sports.
In recent years, hip replacement surgery has evolved significantly with the introduction of minimally invasive and innovative techniques aimed at reducing surgical trauma and enhancing postoperative recovery. Among these, the Direct Superior (DS) Approach has emerged as one of the most promising techniques, as it preserves muscles and tendons, leading to better functional outcomes, reduced rehabilitation time, and less postoperative pain.
Comparing Surgical Approaches
Traditional posterior approaches, such as the posterolateral and mini-posterior techniques, involve cutting through the iliotibial band and the short external rotator tendons, including the quadratus femoris and gemelli muscles.
The Direct Anterior Approach avoids the iliotibial band and quadratus femoris, allowing for earlier ambulation and a lower risk of dislocation.
The Direct Superior (DS) Approach, however, takes this a step further. It is a superior approach to the hip joint that spares the iliotibial band, the external obturator tendon, and the quadratus femoris muscle. The goal of minimally invasive surgery (MIS) is to disturb as little tissue as possible while still allowing optimal exposure of the hip joint and proper implant positioning.
Key Benefits of the Direct Superior Approach
During surgery, the Direct Superior Approach involves a small incision at the upper part of the greater trochanter, allowing access to the hip joint without cutting or detaching major muscles and tendons. Instead, the surgeon gently spreads the muscles apart rather than incising them.
Unlike other techniques that may require dissection or detachment of key muscles such as the gluteus maximus, gluteus medius, gluteus minimus, or tensor fasciae latae, this approach preserves the integrity of muscle and tendon structures, promoting a faster and smoother recovery.
With its ability to minimize tissue damage, enhance functional outcomes, and accelerate rehabilitation, the Direct Superior Approach represents a significant advancement in hip replacement surgery, offering patients a quicker return to normal activities with less pain and improved mobility.
The Advantages of the Direct Superior Approach in Hip Prosthesis Surgery
The benefits of this technique, which led me to adopt it, include:
1. Enhanced Post-Operative Functionality
By preserving the primary hip stabilizers, this approach allows patients to regain mobility more quickly, reducing the need for prolonged rehabilitation. In fact, patients are able to stand and walk with full weight-bearing on the same day as surgery.
2. Less Post-Operative Pain
Since the Direct Superior Approach avoids detaching major muscles, the surgical trauma is significantly reduced. This results in less post-operative pain, enabling faster mobilization and decreasing the need for pain medications.
3. Lower Risk of Hip Dislocation
Hip joint stability is largely dependent on the strength and integrity of surrounding muscles and tendons. With the Direct Superior Technique, the risk of post-operative dislocation is considerably lower compared to other surgical approaches, as the stabilizing muscles remain intact.
4. Faster Recovery Times
The combination of reduced pain, improved functionality, and minimal tissue trauma leads to a significantly quicker recovery. Many patients can walk within a few hours after surgery and return to daily activities much faster than with traditional techniques.
5. Shorter Surgical Duration
In experienced hands, a Direct Superior hip replacement for uncomplicated osteoarthritis takes no more than 30 minutes. This translates into less blood loss (minimizing the need for transfusions), reduced post-operative pain, and a significantly lower risk of prosthetic infections—one of the most serious and disabling complications.
Since adopting this technique in 2019, I have observed a substantial reduction in infection rates among over 1,000 hip implants performed with the Direct Superior Approach:
- Only one deep infection, requiring two additional surgeries.
- Two minor infections, successfully treated with antibiotics.
- Significant decrease in blood loss, minimizing the need for transfusions.
- Dramatic reduction in dislocation rates.
Additionally, the minimally invasive nature of the Direct Superior Approach has allowed me to successfully perform approximately 70 simultaneous bilateral hip replacements. This means that patients with bilateral hip disease can undergo a single anesthesia, a single surgery, a single hospitalization, and a single rehabilitation cycle, addressing both hips in one procedure.
A Step Forward in Hip Surgery
At Arsbiomedica, this modern approach to hip replacement—despite requiring a significant learning curve and expert surgical hands—has demonstrated outstanding results, particularly in reducing complications and accelerating recovery. Advances in prosthetic technology, longer-lasting biocompatible materials, and increasingly less invasive techniques are transforming hip replacement surgery from a highly invasive procedure into one with minimal impact on patients.
The future of hip surgery is increasingly muscle-preserving, aiming to minimize soft tissue trauma and ensure rapid, full functional recovery. The Direct Superior Approach represents one of the most significant advancements in this direction, offering new hope for those in need of hip replacement surgery.
